Transjugular intrahepatic portosystemic shunts (TIPS)

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Transjugular intrahepatic portosystemic shunts


Only a few studies have reported on the effects of
transjugular intrahepatic portosystemic shunts (TIPS) in
patients with type 1 HRS. This procedure consists of
insertion of an intrahepatic stent between the portal and
hepatic veins by a transjugular approach. The main effect
is to lower portal pressure.
In type 1 HRS, TIPS improve
circulatory function and reduce the activity of
vasoconstrictor system.These effects are associated
with a slow, moderate to strong increase in renal perfusion
and GFR and a fall in serum creatinine concentrations in
about 60% of patients. Median survival after TIPS in
type 1 HRS is between 2 months and 4 months.As
with vasoconstrictor drugs, the improved renal function
probably, but not definitely, results in longer survival.
Information currently available on the use of TIPS in type
1 HRS has been obtained in a very selected population of
patients and may not be applicable to the whole
population of such patients. In fact, TIPS are thought to
be contraindicated in patients with severe liver failure
(high serum bilirubin concentrations and/or Child-Pugh
score greater than 12) or severe hepatic encephalopathy
because of the risk of inducing irreversible liver failure or
chronic disabling hepatic encephalopathy. No studies
have been reported that compared TIPS and
vasoconstrictors in type 1 HRS. Until comparative studies
are undertaken, vasoconstrictors appear to be the
treatment of choice in type 1 HRS because of apparently
similar efficacy, wider availability, and lower costs than
TIPS.

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